Fillable APPLICATION FOR LONG-TERM LOAN OR GUARANTEE Export-Import Bank (Export-Import Bank of the United States)

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APPLICATION FOR LONG-TERM LOAN OR GUARANTEE Export-Import Bank (Export-Import Bank of the United States)

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Export-Import
Bank
of the United States
APPLICATION
FOR LONG-TERM LOAN OR
GUARANTEE
This application is to be used for direct loan and guarantee transactions with financed amounts over $10 million (excluding financed
premium), typically with tenors over seven years. It may also be used for certain EXIM products and programs regardless of
transaction size or tenor including: Large Aircraft, Limited Recourse and Structured Financing, and Tied Aid. (To request a Credit
Guarantee Facility, please complete the
Medium-Term
application.)
Additional information on how to apply for EXIM long-term loans and guarantees can be found at EXIM’s web site http://
exim.gov/tools-for-exporters//applications-forms
Send this completed application to EXIM, 811 Vermont Avenue, NW,
Washington,
DC 20571. EXIM will also accept e-mailed
PDF applications. Please note that applications must be PDF scans of original applications and all required application attachments.
(e-mail
exim.applications@exim.gov).
Hard copies of required supporting
documentation
may still be required for limited recourse
and structured financing requests.
APPLICATION
FORM
1.
COMMITMENT
OR
FINANCING
TYPE REQUESTED
A. Product
☐
Comprehensive
Guarantee
☐ Political Risk Guarantee
☐ Direct Loan
☐
Preliminary Commitment - See Preliminary Commitment Fact Sheet for eligibility criteria. A justification for a
Preliminary Commitment is to be attached. (https://www.exim.gov/tools-for-exporters/applications-forms)
B Conversion of a
Preliminary Commitment
or a Letter of Interest
☐
No
☐
Yes. The
EXIM
reference
number
is:
_______________________________________
C. Resubmission
☐ Check if this is a
resubmission
of an application that was previously deemed incomplete or
was
withdrawn
for
other
reasons.
The
EXIM
reference
number
is:
__________________
2.
*Applicant Legal Name:
Tradestyle:
*Business Address:
*City:
*State: *Zip + 4:
*
Primary Industry NAICS
1
:
*Corporate Ownership:
*Total Number of Employees:
*Annual Sales Volume:
Contact Person:
Email:
Position Title:
Phone:
Fax:
PARTICIPANTS:
Items marked with an asterisk (*) are required fields. Under corporate ownership, provide name of ultimate parent company, if there is a corporate
owner. For number of employees and sales volume, aggregate for the company and all its affiliates
2
, including corporate owners and subsidiaries.
Duns #:
Taxpayer ID#:
Country:
Does the Applicant have any affiliates
2
?
Yes
No
1
A company’s Primary Industry NAICS code is the NAICS that accounts for the largest share of sales for the most recently completed fiscal year.
The full definition of “primary industry” is set forth at 13 C.F.R. § 121.107.
2
Affiliations exist when one individual or entity controls or has the power to control another or when a third party or parties control or have the power
to control both. Factors such as common ownership, common management, previous relationships with or ties to another entity, and contractual
relationships may cause affiliation. The complete definition of affiliation is found at 13 C.F.R. § 121.103.
*
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Page 1 of 10
Exporter. The exporter is the U.S. entity that contracts with the buyer for the sale of the U.S. goods and
services.
☐ Check if the exporter is the applicant. Otherwise, complete the information below for each exporter,
including
ancillary service providers.
Supplier. The supplier is the U.S. company that manufactures the goods and/or performs the services to be
exported.
☐ Check if the supplier is also the exporter. Otherwise, complete the information below for
each
supplier, including
ancillary service
providers.
*Exporter Legal Name:
Tradestyle:
*Business Address:
*City:
*State: Zip + 4:*
* Does the exporter have any affiliates
2
?
* Primary Industry NAICS
1
:
Corporate Ownership:*
*Total Number of Employees:
*Annual Sales Volume:
Contact Person:
Email:
Position Title:
Phone:
Fax:
*Minority-owned business:
*Woman-owned business:
*Veteran-owned business:
Yes
No
Yes
Yes
No
No
Decline to Answer
Decline to Answer
Decline to Answer
Duns #:
Taxpayer ID#:
Country:
Items marked with an asterisk (*) are required fields. Under corporate ownership, provide name of ultimate parent company, if there is a corporate
owner. For number of employees and sales volume, aggregate for the company and all its affiliates
2
, including corporate owners and subsidiaries.
*Supplier Legal Name:
Tradestyle:
*Business Address:
*City:
*State: Zip + 4:*
* Primary Industry NAICS
1
:
Corporate Ownership:*
*Total Number of Employees:
*Annual Sales Volume:
Contact Person:
Email:
Position Title:
Phone:
Fax:
*Minority-owned business:
*Woman-owned business:
*Veteran-owned business:
Yes
No
Yes
Yes
No
No
Decline to Answer
Decline to Answer
Decline to Answer
Duns #:
Taxpayer ID#:
Country:
Applicant’s role in the transaction:
☐ exporter ☐ buyer/ borrower ☐ lender (if lender is applicant, lenders mandate must be attached)
Primary contact point for EXIM inquiries on this transaction: ☐ exporte
r ☐ lender
☐ borrower
*Minority-owned business:
*Woman-owned business:
*Veteran-owned business:
Yes
No
Yes
Yes
No
No
Decline to Answer
Decline to Answer
Decline to Answer
*Does the supplier have any affiliates
2
?
Yes
No
Items marked with an asterisk (*) are required fields. Under corporate ownership, provide name of ultimate parent company, if there is a corporate
owner. For number of employees and sales volume, aggregate for the company and all its affiliates
2
, including corporate owners and subsidiaries.
Yes
No
1
A company’s Primary Industry NAICS code is the NAICS that accounts for the largest share of sales for the most recently completed fiscal year.
The full definition of “primary industry” is set forth at 13 C.F.R. § 121.107.
2
Affiliations exist when one individual or entity controls or has the power to control another or when a third party or parties control or have the power
to control both. Factors such as common ownership, common management, previous relationships with or ties to another entity, and contractual
relationships may cause affiliation. The complete definition of affiliation is found at 13 C.F.R. § 121.103.
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Page 2 of 10
Borrower. The borrower is the entity that agrees to repay the
loan.
☐ Check if the borrower is the applicant. If not, complete the information
below.
Borrower n
ame: _
_
_________________________________________ Duns
#: __________________________________
Contact
person: ___________________________________________ Phone
#: _________________________________
Position
title: _____________________________________________ Fax
#:
__________________________________
Business
address: _________________________________________
E-mail:
__________________________________
City: ________________________________ State/Province: ___________ Postal
code: ________________________
Taxpayer
ID
#: ___________________________________________________________________________________
Country: ________________________________________________________________________________________
Guarantor. The guarantor is the person or entity that agrees to repay the credit if the borrower does
not.
Complete the information below for each guarantor if a guarantor is offered or
required.
Guarantor name: __________________________________________ Duns
#: __________________________________
Contact
person: ___________________________________________ Phone
#: _________________________________
Position
title: _____________________________________________ Fax
#:
____________________________
__
___
Business
address: ____________________________________
___
__
E-mail:
_______
_____
__________
_
___
______
__
City: ____________________________ State/Province: ______________ Postal
code: ________________________
Country: _________________________________________________________________________________________
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Buyer. The buyer is the entity that contracts with the exporter for the purchase of the U.S. goods and
services.
☐ Check if the buyer is also the ☐ borrower or ☐ guarantor. Otherwise, complete the information
below.
Buyer nam
e: _____________________________________________ Duns
#: __________________________________
Contact
person: ___________________________________________ Phone
#: _________________________________
Position
title: _____________________________________________ Fax
#:
__________________________________
Business
address: _________________________________________
E-mail:
__________________________________
City: ______________________ State/Province: ______________ Postal
code: ______________________________
Country: _________________________________________________________________________________________
End-user. The end-user is the foreign entity that uses the U.S. goods and
services.
☐ Check if the end-user is also the ☐ borrower or ☐ guarantor or ☐ buyer. Otherwise, complete the information
below.
End-user name: ___________________________________________ Duns
#: __________________________________
Contact
person: ___________________________________________ Phone
#: _________________________________
Position
title: _____________________________________________ Fax
#:
__________________________________
Business
address: _________________________________________
E-mail:
__________________________________
City: ______________________ State/Province: ______________ Postal
code: ______________________________
Country: ________________________________________________________________________________________
_
Lender. The lender is the company that extends the EXIM guaranteed or insured loan to the
Bo rrower.
☐ Check if the lender is also the ☐ applicant. Otherwise, complete the information
below.
Lender nam
e: ________________ Duns# ______________________ MGA
#: _________________________________
Contact
person: ___________________________________________ Phone
#: _________________________________
Position
title: _____________________________________________ Fax
#:
__________________________________
Business
address: _________________________________________
E-mail:
__________________________________
City: ______________________ State/Province: ______________ Nine
digit
zip
code: ________________________
Country: _________________________________________________________________________________________
Controlling Sponsor. The controlling sponsor is a person providing controlling direct private equity investment
(excluding
investments made through publicly held investment funds, publicly held securities, public offerings, or
similar
market
vehicles) in connection with a
financing.
☐ Check if the Controlling Sponsor is the ☐ applicant. Otherwise, complete the information
below.
.
Sponsor Name: __
_________________________________________ Duns
#: __________________________________
Contact
person: ___________________________________________ Phone
#: _________________________________
Position
title: _____________________________________________ Fax
#:
__________________________________
Business
address: _________________________________________
E-mail:
__________________________________
City: ______________________ State/Province: ______________ Nine
digit
zip
code: ________________________
Country:
_________________________________________________________________________________________
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3. DETAILS OF
COVERAGE
REQUESTED
A. Special Features Requested
Check the boxes for the coverage that apply
to the transaction. View the fact sheets describing the coverage on
EXIM’s web site as noted below. Complete and attach the requested forms.
☐ Large Aircraft
Attachment A required
☐ Project Finance
Attachment F required
☐ Foreign Currency Guarantee
(specify currency)
http://exim.gov/what-we-do/loan-
guarantee/foreign_currency-
guarantee
☐ Local Cost Support
http://exim.gov/policies/
local_cost
th is do c um e nt )
☐ Used
Equipment
Attachment E required
http://exim.gov/policies/
used-equipment
☐ Nuclear
http://exim.gov/policies/ex-im-
bank-and-the-environment
/international-environmental-and-
social
-guidelines
http://exim.gov/about/
special-initiatives/environment
☐ Ancillary Service Fees
☐ Tied Aid Program
Attachment C required
☐ Finance Lease Structure
http://exim.gov/what-we-do/
finance-lease-guarantee
http://exim.gov/policies/
military
☐ Other
☐
Other
☐ Other
4.
TRANSACTION
DESCRIPTION
a) Describe Goods and Services. Include make, model,
manufacturer/supplier,
NAICS of goods and services, number of units,
values, and estimated U.S. and foreign content.
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44444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444!!
b) Describe the purpose of the transaction. Include answers to the following: Will the goods be used to create or expand
produc- tion capacity for an exportable product? Are the goods and services destined for an identifiable project? If so,
provide information on the total estimated project cost in US dollars. Also provide information as to other sources of
financing for the project, including working capital.
44444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444!!
44444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444!!
c) Indicate whether an application for support of this export contract or a related project has been filed with the Agency for
International Development,
Maritime
Administration,
Overseas Private Investment
Corporation,
Trade
Development
Agency or a multilateral financing agency. If so, include a brief description of the additional support.
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http://exim.gov/sites/default/
files/forms/ebd-m-13.pdf
OMB 3048-0013
Expires 08/31/2022
EIB 95-10 (Rev. 2/2019)
Page 5 of 10
5.
REQUESTED FINANCING AMOUNTS
AND STRUCTURE
EXIM support is based on the value of the eligible goods and services in the exporter’s supply contract(s) or purchase
order(s). The total level of support will be the lesser of: 85% of the value of all eligible goods and services; or 100% of
the U.S. content included in all eligible goods and services in the exporter’s supply contracts. In addition, EXIM may also
finance certain local costs, ancillary services as approved, and the exposure
fee/premium.
Fill out the chart below to
determine estimated eligible amounts.
Definition
US$
A
Supply Contracts or
Purchase Orders
The aggregate price of all goods and services in all the
supply contract(s) or purchase order(s), including local
costs, ancillary services, and excluded goods and services.
Break out ancillary services in Aii.
Ai _____________
Aii _____________
B
Excluded Goods and
Services
The aggregate price of all goods and services that are not
eligible for or are excluded from EXIM support (e.g.
goods not shipped from the U.S. and excluded ancillary
services). Local costs should not be included in this line.
!!4444444444444444!
C
Total Local Costs
!!4444444444444444!
D
Net Contract Price
A minus B minus C
!!4444444444444444!
E
Eligible Foreign
content
!!4444444444444444!
F
U.S. Content
D minus E
!!4444444444444444!
G
Cash Payment
This amount must be the greater of E or 15% of D
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H
Local Cost
Financing Requested
This can be no more than 30% of D
!!4444444444444444!
I
Financed
Amount Requested
(Excluding Exposure
Fee)
D minus G plus H
!!4444444444444444!
A. Exposure Fee. Check one
box.
☐ EXIM to finance the fee, which will be paid as the credit is drawn
down.
☐ EXIM to finance the fee, which will be paid up
front.
☐ EXIM will not finance the fee, and it will be paid as the credit is drawn
down.
☐ EXIM will not finance the fee, and it will be paid up
front.
B. Transaction
Structure.
i. Principal Repayment Term. (years). Unless otherwise requested, equal installments of principal
will
be repaid semi-annually beginning six months after the starting
point.
The aggregate cost of any goods (or components thereof)
produced or manufactured outside the U.S, or services
provided by third country personnel, foreign freight costs
and foreign insurance included in the net contract price
(line D), (e.g. foreign items exported from the US)
The aggregate price of all goods originated/manufactured
in the Purchaser's country and all services provided by
residents purchaser’s country. EXIM may be able to
finance these amounts up to 30% of D below.
OMB 3048-0013
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EIB 95-10 (Rev. 2/2019)
Page 6 of 10
ii Starting Point. The starting point is generally the event that marks the fulfillment of the exporter’s
contractual
responsibility. See EXIM’s fact sheets on starting points and reach-back policies at
www.exim.gov.
(Check one
box.)
☐ Shipment (single shipment) ☐ Services
Completion.
☐ Final Shipment (multiple shipments) ☐ Completion of Installation. Specify
date:
______________
☐
Mean
Shipment (multiple shipments) ☐ Project Completion. Specify
date:
_______________________
☐
Other
iii Shipment Period. Shipments will be completed and/or services will be performed
from:
[ ] (month/year) to [ ] (month/year) excluding any acceptance,
retention,
or warranty
period.
iv. Interest
rate.
The
interest
rate
to
be
charged
on
the
guaranteed
loan
is: ______________________________________________
6. REASON FOR
REQUESTING
EXIM SUPPORT.
The basic rationale for EXIM support is that the export of U.S. goods and services needs financing but there
are
one
or more obstacles to obtaining such financing. Please check all the boxes below that apply to this transaction,
to the
best
of
your
knowledge.
Please
also
check
the
appropriate
box
to
indicate
which
factor
is
most
important.!!
!
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OMB 3048-0013
Expires 08/31/2022
EIB 95-10 (Rev. 2/2019)
Page 7 of 10
7. CREDIT INFORMATION
The credit information outlined in the following is
attached.
☐ Large Aircraft (Attachment
A)
☐ Long-Term and Structured Transactions ( Attachment
G)
☐ Limited Recourse Project Finance (Attachment
F)
8. OTHER
INFORMATION
AND
CERTIFICATIONS
A. General Information - Provide the
following:
☐ Credit Agency report(s) on the exporter(s). If exporter has a credit rating of BBB or better, this is not
required.
☐ Annex A to the Master Guarantee Agreement (Guarantees only)
at https://www.exim.gov/sites/default/files//forms/mtmgaannexes.pdf
☐ Lender’s mandate letter (required when applicant is a financial
institution).
☐ Environmental Screening (attachment
B).
B. Supply Contracts Between the Exporter and
Buyer.
☐ Sales contract(s), pro forma invoice(s), or purchase order(s) are
attached.
☐ No contract is attached. (Project Finance and Preliminary Commitments
only)
C. Commitment Fee
Agreement.
A commitment fee accrues starting 60 days after the authorization of a final commitment and is payable
semiannually
in arrears on a schedule determined at the time of authorization. The commitment fee is 1/8 of
1% per annum on
the
un-disbursed and un-cancelled balance of a guaranteed loan or 1/2 of 1% per annum for a direct
loan. Choose one of
the
options below regarding the payment of the commitment
fee:
☐ The applicant is the borrower, and by signing the application, is irrevocably committing to pay the commitment
fee.
☐ The applicant is the guaranteed lender, and is (check
one):
☐ signing the application which irrevocably commits it to pay the fee,
or
☐ signing the application and enclosing with it an EXIM standard form fee letter from the
borrower
(at https://www.exim.gov/sites/default/files/forms/mtmgaannexes.pdf). This letter irrevocably commits the
borrower to pay the
fee.
☐ The applicant is the exporter, and is signing the application and enclosing with it an Ex-Im Bank standard
form
fee
letter from the ☐ borrower or ☐ guaranteed lender (at https://www.exim.gov/sites/default/files/forms/mtmgaannexes.pdf).
This letter irrevocably commits the borrower or guaranteed lender to pay the
fee.
D. Anti-Lobbying Disclosure
Form
Please refer to the Anti-Lobbying Declaration/Disclosure forms (see Attachment D)
and
include a signed copy of the
appropriate form(s) with your
application.
OMB 3048-0013
Expires 08/31/2022
EIB 95-10 (Rev. 2/2019)
Page 8 of 10
LONG-TERM LOAN OR GUARANTEE APPLICATION ATTACHMENTS
Attachment A (Form EIB 95-10a): Large Aircraft Transactions
Attachment B (Form EIB 95-10b): Environmental Screening Document
Attachment C (Form EIB 95-10c): Tied Aid Capital Project Fund
Attachment D (Form EIB 95-10d): Anti-lobbying Declaration/Disclosure
Attachment E (Form EIB 11-03): Used Equipment Questionnaire
Attachment F (Form EIB 95-10f): Project and Structured Finance
Attachment G (Form EIB 95-10g): Credit Information
Attachment H (Form EIB 11-04): Co-financing with Foreign Export Credit Agency
OMB 3048-0013
Expires 08/31/2022
EIB 95-10 (Rev. 2/2019)
Page 9 of 10
CERTIFICATIONS AND SIGNATURE
Please refer to the “Standard Certifications and Covenants for EXIM Applications” set forth in Form EIB 18-CN, posted
on the EXIM website at https://www.exim.gov/tools-for-exporters/applications-forms/complete-list
(the “Standard
Certifications”). THE STANDARD CERTIFICATIONS ARE INCORPORATED INTO THIS APPLICATION AS IF FULLY
AND DIRECTLY SET FORTH HEREIN. When signing this application in the space provided below, the undersigned
authorized officer signing on the applicant's behalf certifies and represents that he or she is fully authorized to sign on the
applicant's behalf, and that HE OR SHE HAS READ the Standard Certifications referenced above AND IS CERTIFYING
AND COVENANTING, as appropriate, to all of the certifications, acknowledgments and covenants set forth in the
Standard Certifications.
Applicant further certifies that the representations made and the facts stated in this application and its attachments are
true and Applicant has not misrepresented or omitted any material facts. Applicant further covenants that if any
statement set forth in this application or in the Standard Certifications, becomes untrue, or is discovered to have been
untrue when made, Applicant will promptly inform EXIM of all such changes or discoveries. Applicant further understands
that in accepting or approving this application, EXIM is relying upon Applicant's statements set forth in the application
and in the Standard Certifications, and all statements and certifications to EXIM are subject to the penalties for false or
misleading statements to the U.S. Government (18 USC § 1001, et. seq.).
I, , do hereby certify that I am the duly appointed and qualified
(Title)
of and that as such I am authorized to execute this application
(Name of Applicant)
on behalf of .
(Name of Applicant)
day of . 20 .
NOTICES
The applicant is hereby notified that information requested by this application is done so under authority of the Export-Import Bank Act of 1945, as
amended (12 USC 635 et. seq.); provision of this information is mandatory and failure to provide the requested information may result in EXIM being
unable to determine eligibility for support. If any of the information provided in this application changes in any material way or if any of the certifications
made herein become untrue, the applicant must promptly inform EXIM of such changes. The information provided will be reviewed to determine the
participants’ ability to perform and pay under the transaction referenced in this application. EXIM may not require the information and applicants are
not required to provide information requested in this application unless a currently valid OMB control number is displayed on this form (see upper right
of each page). EXIM reserves the right to decline to process or to discontinue processing of an application.
Paperwork Reduction Act Statement:
We estimate that it will take you about 1.75 hour s to complete this form. This includes the time it will take to read
the instructions, gather the necessary facts and fill out the form. However, you are not required to provide information requested unless a valid OMB
control number is displayed on the form. If you have comments or suggestions regarding the above estimate or ways to simplify this form, forward
correspondence to EXIM and the Office of Management and Budget, Paperwork Reduction Project, OMB# 3048-0013 Washington, D.C. 20503
OMB 3048-0013
Expires 08/31/2022
EIB 95-10 (Rev. 2/2019)
Page 10 of 10
By:
(Authorized Officer)
Name:
Title:
Tel. #:
Email:
In witness whereof, I have hereunto signed my name this
Name of Applicant:
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APPLICATION FOR LONG-TERM LOAN OR GUARANTEE Export-Import Bank (Export-Import Bank of the United States)

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Completed 10 August 2020

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